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Glenoid Component Retroversion Is Associated with Osteolysis
Jason C. Ho, MS1; Vani J. Sabesan, MD2; Joseph P. Iannotti, MD, PhD3
1 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, NA21, Cleveland, OH 44195
2 Department of Orthopaedic Surgery, Western Michigan University School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008
3 Orthopaedic and Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue, A-41, Cleveland, OH 44195. E-mail address: iannotj@ccf.org
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Investigation performed at the Cleveland Clinic, Cleveland, Ohio

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jun 19;95(12):e82 1-8. doi: 10.2106/JBJS.L.00336
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It has been suggested that glenoid component retroversion and eccentric loading are an important mechanism leading to glenoid component loosening, but little clinical data have been published to support this concept.


Sixty-six shoulders underwent total shoulder replacement with an all-polyethylene press-fit pegged glenoid component designed for osseous ingrowth for treatment of osteoarthritis. These shoulders were followed clinically and with radiographs for an average (and standard deviation) of 3.8 ± 1.8 years (range, two to seven years). Preclinical radiographic loosening was defined as osteolysis around the central peg of the glenoid component.


Of the sixty-six shoulders, twenty (30%) had osteolysis around the center peg. The length of time after replacement (p = 0.0006), preoperative glenoid retroversion (p = 0.036), and postoperative glenoid component retroversion (p = 0.041) were correlated with osteolysis around the glenoid center peg and an increase in the Lazarus component loosening grade. Postoperative retroversion correlated with preoperative retroversion (Pearson correlation coefficient = 0.44, 95% confidence interval [CI] = 0.19 to 0.64, p = 0.0011). The presence of osteolysis around the center peg was not correlated with a worse clinical outcome defined by shoulder scores or a reoperation due to glenoid loosening. After adjustment for follow-up time, excessive postoperative glenoid retroversion (≥15°) was associated with an increased odds of osteolysis (odds ratio = 5.23, 95% CI = 1.31 to 20.9]), whereas preoperative glenoid retroversion was associated with no change in the odds of osteolysis.


Osteolysis around the center peg of a glenoid component is correlated with component retroversion of ≥15°. This finding suggests that there should be additional investigation into the effects of correcting preoperative glenoid retroversion to prevent osteolysis around the center peg.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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